When is “sustained”, “unexplained” sensations of fear and distress really the difficult to explain sensation of DYSPNEA?


Paula always has a mild sensation of dyspnea. Paula thinks that this is normal. [who knows? maybe it is.] Now she has learnt the word for this mild form of discomfort. Dyspnea may be a common distressing symptom but it certainly IS NOT a common word. It is jargon used by doctors that ordinary folk do not understand; Paula is more likely to use the words fear, distress, and anxiety, when her dyspnea increases to the point of being unbearable.

So you can see immediately how using incorrect language with a doctor will lead directly to a misdiagnosis.

Language, alone, cannot lead to a correct diagnosis-especially when the doctor and the patient do not speak the same “jargon” and maybe the patient can only barely speak [because they are not well] when in need of a doctor. Only a careful measurement of respiratory rate, blood pressure, heart rate [and signs] and body temperature will detect why the patient feels unwell [often in non specific, but important none the less, ways which may be the KEY to understanding what is wrong.

In Paula’s case, no doctor has ever measured these vital signs together and mindfully and no doctor knows about her deranged ventilation. Paula herself does not know and so cannot enlighten the doctor. Paula’s friends and family cannot tell, and so they cannot enlighten the doctor either,.

The doctor’s JOB is to detect what Paula and others cannot, and sometimes doing a basic first aid evaluation of the autonomic nervous system system when at rest is the KEY, even if measuring the vital signs is no terribly sexy or exciting for the doctor…..until they find the Paula’s respiratory rate is 3 breaths per minute…then it becomes too exciting for most doctors who will freak out and not know how this could be.

That, alone, is fascinating!

A quick review of the autonomic nervous system at rest will help identify the difference between dyspnea versus mood, and will better identify the source of the otherwise problems; Paula’s depressed baseline breathing is easy to discover by having her lie down, and relax, while her breathing rate is counted…., this technique also makes her use of abdominal exhaling is very obvious to the eye.

Background: Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome.

Purpose: The purpose of this document is to update the 1999 ATS Consensus Statement on dyspnea.

Methods: An interdisciplinary committee of experts representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant expertise. The final content of this statement was agreed upon by all members.

Results: Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consistently shown dyspnea stimuli to be correlated with activation of cortico-limbic areas involved with interoception and nociception. Endogenous and exogenous opioids may modulate perception of dyspnea. Instruments for measuring dyspnea are often poorly characterized; a framework is proposed for more consistent identification of measurement domains.

Conclusions: Progress in treatment of dyspnea has not matched progress in elucidating underlying mechanisms. There is a critical need for interdisciplinary translational research to connect dyspnea mechanisms with clinical treatment and to validate dyspnea measures as patient-reported outcomes for clinical trials.” Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calverley PM, Gift AG, Harver A, Lareau SC, Mahler DA, Meek PM, O’Donnell DE; American Thoracic Society Committee on Dyspnea. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012 Feb 15;185(4):435-52. doi: 10.1164/rccm.201111-2042ST. PMID: 22336677; PMCID: PMC5448624

To be continued…still editing…..


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